A yearlong study of boxers' and mixed martial-arts fighters' brain activity has found those who fight for more than six years begin to experience damage and those who fight longer than 12 years expose themselves to an even greater decline each time they return to the ring.

"What we've found suggests changes and damage in the brain happens years before symptoms emerge," said Dr. Charles Bernick, author of the study. "It's what we see in Alzheimer's and Parkinson's patients."

Bernick has supervised MRIs and computerized and cognitive tests of an estimated 170 fighters at the Cleveland Clinic's Las Vegas center in the past year. He will present his findings to the American Academy of Neurology this week in New Orleans.

"If we're going to protect these athletes, we need to follow them earlier in their course," Bernick said.

Currently, fighters are required to undergo only one brain MRI test, which could be taken at the beginning of their career. State commissions can request an additional MRI if they're alarmed by a fighter's age, performance or behavior. But pinpointing when to stop a fight remains an undefined point of discretion.

With his research, Bernick was hoping to help establish the threshold neurologists can use to determine the start of chronic traumatic encephalopathy (CTE), a degenerative brain disease.

CTE emerges in those who suffer multiple concussions and other brain damage that comes with being punched in the head. Symptoms of CTE include memory loss, aggression and difficulty thinking.

Bernick said the study found fighters begin losing brain volume — as brain cells die — after six years of fighting.

Fighters who commit to the Cleveland Clinic program get free MRI tests, but must agree to return annually for monitoring.

"We still need to follow these guys over time," Bernick said. "If someone's having damage, a commission might want to limit the number of fights he has. There is a hierarchy of protective things, interventions to help. This is still being sorted out.

"We are looking at this 'threshold effect.' How much punishment can a brain take? What are the markers we can see for long-term problems?"

The study received a $12-million boost in funding earlier this year from a Las Vegas dinner and auction. One of the highlights of the night was Ultimate Fighting Championship Chairman Lorenzo Fertitta outbidding Dallas Cowboys owner Jerry Jones, spending $1.1 million for a pair of autographed gloves belonging to Muhammad Ali.

There are many things to love about football. For kids, it builds confidence. It promotes teamwork. It is fun. It is a physical game but it is a cerebral one, too. The bonds guys make playing football last a lifetime.

The questions for those who play are how long is that lifetime and what does it look like at age 40 or 50 or 60?

For the men who play in the NFL, the questions become more serious. Can you find your keys or remember you mom's phone number when you are 38? Do you have searing headaches? Are you depressed? Can you walk?

Woof all - here's a couple links to something that I think will fairly rapidly become a standard in youth sports and hopefully all contact sports. I think within a couple years you will see this as a required part of athletic physicals, certainly for contact sports. I think that smart gym owners will start obtaining baselines to show responsibility and concern (attorneys might argue not to, as this could provide documentation of what is otherwise a subjective injury; they may be right but I hope the best defense is to do the right thing). The big problem with the test is that to be really effective you need a baseline BEFORE injury for each individual, and access to that number on the sideline rapidly. I think football team rosters or team trainers in the future will have a new baseline on each player each season and have it available at the sidelines as routine operating procedure. It is easy to do and only takes 3-5 minutes max once you have it down.

Woof all - as I noted above, the iPad version is a lot better than the iPhone version - as it turns out, that's because the iPhone version is not intended for actually administering the test, just as a timer/scoring device - the test needs to be administered with cards, iPad or computer and the iPhone app is strictly for obtaining the score in time and errors. Seems the King Devick people ran across the video and sent word to Guro Crafty and me to notify us of the error! Mea culpa, but I'm still playing with this and learning it myself. For those who are interested , here is the official demo site for videos of how to perform properly.

You're being humble and polite here. As best as I can tell THEY glitched a bit with how they presented the info; I trust that given the experience with us they will be clarifying things so that more folks do not understandably come to the same conclusion you did.

THE beating goes on. This past Saturday a Tulane University football player, Devon Walker, collided with a teammate while making a tackle. Walker, who is 21, broke his neck. Fans gasped. Doctors performed C.P.R. He may or may not walk again.

The incident was an urgent reminder of a problem that even the National Football League seems finally ready to acknowledge: all that on-field headbanging is taking a serious toll.

Just three days earlier, the N.F.L. said that it would donate $30 million to the National Institutes of Health to support research on brain injuries and other serious medical conditions prominent in athletes — an announcement that came hours before the Giants and Cowboys kicked off the 2012-13 season in a festive, nationally televised event that drew more than 20 million viewers. (For comparison, that rivals the number of Americans who tuned in to Bill Clinton’s speech at the Democratic National Convention the same night.)

Earlier that day, the journal Neurology carried the results of a study of 3,439 retired pro football players. It reported that veterans of N.F.L. combat are more likely than the rest of us to die from brain diseases including Alzheimer’s, Parkinson’s and amyotrophic lateral sclerosis, known as Lou Gehrig’s disease. Not 50 percent more likely, or twice as likely, but three to four times more likely.

America’s ready for some football, but the human brain may never be.

More than 3,000 former players have sued the N.F.L., charging that the league failed to inform them of the dangers they faced, to protect them against concussions and to provide health care. Those men played in the years when nobody talked about getting “concussed.” You got your bell rung, your clock cleaned. You got nuked or blown up. You got your head handed to you. And unless you liked being called frilly names, you got back on the field as soon as you could locate it.

We know more about concussions today, but not how to prevent them. No helmet can offer much help, since the injury occurs when a fast-moving body suddenly stops or changes direction. The brain keeps moving until it collides with the inside of the skull, causing damage that can lead to chronic traumatic encephalopathy, or C.T.E.

Sports science’s next frontier may be discovering why some brains are so vulnerable to concussions while others seem resistant. Meanwhile, it is heartbreaking when football heroes wind up in wheelchairs or worse. John Mackey, the pioneering president of the N.F.L. Players’ Association, was found to have frontal temporal dementia in his early 60s. Former Bears safety Dave Duerson was 50 years old when he committed suicide, shooting himself in the chest so that his brain could be studied. (It showed signs of C.T.E.) Junior Seau, a 12-time Pro Bowler for the Chargers, was 43 when he shot himself in the chest last spring.

Fans may wonder whether they should support such a sport. Many parents face a more practical question: Should our kid play football? When the Raiders’ Phil Villapiano, one of the hardest hitters in N.F.L. history, watched his son Mike get his bell rung in a high school game, they had a father-son talk about it. Mike dreamed of playing college football, maybe even making the N.F.L. They both felt he wouldn’t get there by sitting on the sidelines, waiting for a doctor to send him back in. Father and son agreed: Mike kept his mouth shut and his options open. He stayed in the game and led his team to a state championship.

I’m not about to second-guess the Villapianos, whose fortitude I admire. But no family should face such a choice.

The N.F.L. now uses simple written or computerized cognitive tests to assess concussions. Before each season, players are shown a page featuring 20 words and asked to write down as many as they remember when the page is taken away. The same with 20 simple pictures: Draw as many as you can remember. Later, after an on-field hammering rings their mental bells, the pros take the same test. Match your baseline results or sit out.

Some players cheat. They purposely give wrong answers on the preseason baseline test in hopes of passing the test when they’re concussed. But no screening plan is foolproof, and this one has the virtue of simplicity. Every college and high school football program should use such a test until we find something better. Above all, though, football needs a culture change: parents, coaches and fans must never pressure an injured player to “get back in the game” before it’s clear that he’s of sound mind and body.

How should we view last week’s donation from the N.F.L. to the N.I.H.? Cynics will no doubt see the pledge as a cheap public relations move. Given that $30 million represents four and a half minutes of commercial time during the Super Bowl, the league’s donation might seem paltry.

But it’s a start.

Kevin Cook is the author of “The Last Headbangers: NFL Football in the Rowdy, Reckless ’70s — the Era That Created Modern Sports.”

The growing evidence of a link between head trauma and long-term, degenerative brain disease was amplified in an extensive study of athletes, military veterans and others who absorbed repeated hits to the head, according to new findings published in the scientific journal Brain.

The study, which included brain samples taken posthumously from 85 people who had histories of repeated mild traumatic brain injury, added to the mounting body of research revealing the possible consequences of routine hits to the head in sports like football and hockey. The possibility that such mild head trauma could result in long-term cognitive impairment has come to vex sports officials, team doctors, athletes and parents in recent years.

Of the group of 85 people, 80 percent (68 men) — nearly all of whom played sports — showed evidence of chronic traumatic encephalopathy, or C.T.E., a degenerative and incurable disease whose symptoms can include memory loss, depression and dementia.

Among the group found to have C.T.E., 50 were football players, including 33 who played in the N.F.L. Among them were stars like Dave Duerson, Cookie Gilchrist and John Mackey. Many of the players were linemen and running backs, positions that tend to have more contact with opponents.

Six high school football players, nine college football players, seven pro boxers and four N.H.L. players, including Derek Boogaard, the former hockey enforcer who died from an accidental overdose of alcohol and painkillers, also showed signs of C.T.E. The study also included 21 veterans, most of whom were also athletes, who showed signs of C.T.E.

The study was conducted by investigators at the Boston University Center for the Study of Traumatic Encephalopathy and the Veterans Affairs Boston Healthcare System, in collaboration with the Sports Legacy Institute. It took four years to complete, included subjects 17 to 98 years old, and more than doubled the number of documented cases of C.T.E. The investigators also created a four-tiered system to classify degrees of C.T.E., hoping it would help doctors treat patients.

The volume of cases in the study “allows us to see the disease at all stages of severity and how it starts and spreads in the brain, which gives us an idea of the mechanism of the injury,” said Ann McKee, the main author of the study, who is a professor of neurology and pathology at Boston University School of Medicine and works at the V.A. Boston.

Those categorized as having Stage 1 of the disease had headaches and loss of attention and concentration, while those with Stage 2 also had depression, explosive behavior and short-term memory loss. Those with Stage 3 of C.T.E., including Duerson, a former All-Pro defensive back for the Chicago Bears who killed himself last year, had cognitive impairment and trouble with executive functions like planning and organizing. Those with Stage 4 had dementia, difficulty finding words and aggression.

Despite the breadth of the findings, the study, like others before it, did not prove definitively that head injuries sustained on the field caused C.T.E. To do that, doctors would need to identify the disease in living patients by using imaging equipment, blood tests or other techniques. Researchers have not been able to determine why some athletes who performed in the same conditions did not develop C.T.E.

The study also did not demonstrate what percentage of professional football players were likely to develop C.T.E. To do that, investigators would need to study the brains of players who do not develop C.T.E., and those are difficult to acquire because families of former players who do not exhibit symptoms are less likely to donate their brains to science.

“It’s a gambler’s game to try to predict what percentage of the population has this,” said Chris Nowinski, a co-author of the study and a co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. “Many of the families donated the brains of their loved ones because they were symptomatic. Still, this is probably more widespread than we think.”

Researchers expected the details in the study to dispel doubts about the likelihood that many years of head trauma can lead to C.T.E. The growing connections between head trauma and contact sports, though, have led some nervous parents and coaches to assume that any concussion could lead to long-term impairment. Some doctors say that oversimplifies matters. Rather, the total amount of head trauma, including smaller subconcussive hits, as well as how they were treated, must be considered when evaluating whether an athlete is more at risk of developing a disease like C.T.E.

“All concussions are not created equal,” said Robert Cantu, a co-author of the study and a co-director of the encephalopathy center. “Parents have become paranoid about concussions and connecting the dots with C.T.E., and that’s wrong. The dots are really about total head trauma.”

“Do your children play football?” I asked Kevin Guskiewicz the other day over breakfast. “Yes,” he replied, as I nearly fell off my chair. “My 16-year-old and my 12-year-old played football this year. They had a great experience.”

Guskiewicz is, among other things, the chairman of the department of exercise and sports science at the University of North Carolina here. His primary area of study is the connection between recurring concussions, depression and cognitive impairment. At their worst, these are symptoms of a degenerative brain disease called chronic traumatic encephalopathy, or C.T.E. Guskeiwicz’s research on the lasting damage repeated concussions can do to a football player’s brain helped convince the National Football League to tinker with the rules to make the game’s most dangerous play — the kickoff — a little less dangerous. He has been awarded a MacArthur “genius” grant and has been profiled by Malcolm Gladwell in The New Yorker.

Which is why I had naturally assumed that he would be opposed to children playing full-contact football. C.T.E. is a disease that used to be associated solely with boxers. (Indeed, it used to be called “dementia pugilistica.”) But over the past eight or nine years, researchers like Guskiewicz have been studying its effect on other athletes, especially football players.

Thanks not only to their work, but also to a rash of suicides by former (and in several cases, current) football players, as well as lawsuits that have been filed against both the N.F.L. and the N.C.A.A., the issue has gotten enormous visibility. Picking up on the news, many parents now don’t let their children play football because, after all, we all know it is too dangerous. Don’t we?

As I discovered after talking to a number of brain researchers who are studying C.T.E., the science really isn’t able to make that definitive claim — at least not yet. What we know for sure is that multiple concussions can lead to C.T.E. Dr. Ann McKee, a co-director at Boston University’s Center for the Study of Traumatic Encephalopathy, recently published a study with colleagues that examined, posthumously, brain samples of 85 people who had repeated mild brain trauma as opposed to concussions. Some 80 percent of them, the study found, showed evidence of C.T.E.

Does this mean that football players are more likely to get C.T.E., just because of the relentless pounding they take? Yes, says McKee: “Exposure to the sport itself is associated with this disease.”

Guskiewicz, however, is not yet convinced. “Studies like that clearly show that C.T.E. exists in players without a history of concussions, but they haven’t completely connected the dots. It’s a little like saying that if there are a rash of ankle sprains on a tennis team, and they all wear Nike tennis shoes, then the tennis shoes must be the culprit.”

“I always use the word ‘recognized’ when I talk about concussions,” said a third researcher, Dr. Robert Cantu, who is also a co-director of the Boston University center. After all, he says, in the bad old days — which is really just a few years ago — team doctors often missed signs of a concussion. “If you are convinced that players without a history of concussions really didn’t have concussions, then yes: repetitive head-banging alone can cause C.T.E.,” he says. “But we also know that some 80 percent of mild concussions go unrealized.” Still, he said, “Our data is showing that it is not just recognized concussions but total brain trauma that counts.”

When I asked Cantu if he believed that kids should be allowed to play football, he practically growled at me. “Haven’t you read my book?” he asked. Entitled “Concussions and Our Kids,” and published just a few months ago, it argues that children should be confined to touch football until they turn 14. “The young brain is more vulnerable,” he said. “Besides there is just too much that we don’t know yet.”

So why does Guskiewicz disagree with Cantu — a man with whom he has co-authored many a paper on C.T.E.? Like many people who study C.T.E., Guskiewicz is a football fan. Although there are those who now advocate abolishing football altogether — a pipe dream if ever there was one — his goal is to help make the game safer. Part of that, in his view, is teaching proper techniques that protect the head. “I worry that if we don’t teach the right way to block and tackle early, by the time they get to high school — which is when the physics of the game really changes — it will be too late,” he says.

And what does McKee think about children playing football? When I posed it to her, I could hear her sighing over the phone.

“Where are we?” “Who did we play in the last game?” “What is the date today?”

Those are some of the questions N.F.L. players are asked after they are hit in the head during a game. Next season, they are coming to an iPad.

The mandatory postinjury sideline concussion assessment tool, instituted for the 2012 season along with a baseline test done during physicals at the start of preseason, will now be used in app form by all 32 teams, a method that was tried by a handful of teams in a pilot program last season. The hope is that being able to compare the results of a baseline test and a postinjury test side by side in real time will speed diagnosis and help doctors and trainers recognize when a player should be removed from a game. The league also plans to have independent neurological consultants on the sideline during each game to assist the team physician in diagnosing and treating players.

The players union, which had pushed strongly for independent doctors to be on the sideline, said it was encouraged by the technological advance the new test represented, but it still had questions about how much power the independent consultants would have to make decisions about players. The union wants the independent sideline concussion experts to have almost exclusive authority in detecting concussions and administering tests, in part because it believes team doctors are often busy attending to other injured players, while the concussion experts are there for one reason.

“If you’re busy and didn’t see the play, how do you know you need us?” said Dr. Thomas Mayer, the union’s medical director. “This is a big enough issue we need an extra set of eyes, an extra judgment.”

The postinjury test is quick — it takes about six to eight minutes — and shares many elements with the baseline test to allow a comparison that might indicate a decline in function. Both include a section on the players’ concussion history and a 24-symptom checklist; players are asked to score themselves on a scale of 1 to 6 in categories like dizziness, confusion, irritability and sleep problems. Both note any abnormal pupil reaction or neck pain. There is a balance test and a concentration test, in which players, who are usually brought to the locker room to be evaluated, are asked to say the months of the year in reverse order, to recite a string of numbers backward and to remember a collection of words three times. Then they are asked to recall them again, without warning, at least five minutes later. The words and sequence of numbers may be changed from test to test, so players cannot memorize them from a previous test to mask concussion symptoms — a fact that has annoyed players, according to Dr. Margot Putukian, the director of athletic medicine at Princeton University Health Services and a member of the N.F.L.’s Head, Neck and Spine Committee.

On the postinjury tests, there is one different element: a series of five questions designed to test orientation and glean how confused a player might be at that moment. They are: Where are we? What quarter is it right now? Who scored last in the practice or game? Did we win the last game? Those questions, known as Maddocks questions, were developed in the 1990s by an Australian doctor who worked with players in Australian rules football.

“What the application does, when you are evaluating the athlete, you actually see — as they are doing their word recall — his baseline,” said Putukian, who added that it was her understanding that team doctors would administer the tests. “He was able to remember 15 out of 15 words, and now he’s having trouble giving you five back right away? Maybe he’s only able to remember two? It gives you real-time information.”

The tests are far from perfect tools for diagnosing concussions. Some doctors are concerned the N.F.L. tests are trying to reduce concussion evaluation to ticking items off a checklist, a problem Putukian acknowledged, emphasizing the importance of having doctors familiar with the players evaluate them. Last season, Jets running back Shonn Greene took a hit to his helmet in a game and walked unsteadily back toward the huddle before quarterback Mark Sanchez sent him off. Greene later returned to the game, and the Jets said he had passed concussion tests given in the locker room. Also last season, San Francisco quarterback Alex Smith took a hit that caused blurred vision, but he remained in the game for several plays and completed a touchdown pass before being removed. He was subsequently found to have a concussion. While he was out, the backup Colin Kaepernick took over, and Smith effectively lost his starting job.

“I think we have to be careful,” Putukian said. “The tool, it’s not the be-all, end-all. There are going to be athletes who have concussions that this tool does not pick up. It’s not a perfect test. Nor is there one. We don’t have one that is a perfect test.”

She added: “Athletes may take this and perform this test and do fine on it. But you may know the athlete, athletes will stumble through it — ‘Yeah, we played the Seawhawks’ — you know they are struggling. It’s not bang, bang, bang. They’ll give you the right answers, but they are struggling. If you know that athlete, you say: ‘I know you passed the test, but I know you. You’re not O.K.’ ”

For the last two seasons, concussions and hits to the head were frequent talking points in the N.H.L., with the Pittsburgh Penguins star Sidney Crosby serving as the catalyst.

As the lockout dragged on for more than four months, though, the conversation shifted from player safety to revenue percentages and competitive balance. The first few weeks of the shortened 48-game season passed without much talk of concussions. But in the past two weeks, 11 N.H.L. players are believed to have sustained them, among them Crosby’s teammate and the reigning most valuable player, Evgeni Malkin, thrusting the issue of head injuries back into the spotlight.

Concussions continue to plague the league, despite its increased emphasis on reducing them. For the second season, the N.H.L. is playing under its broadened version of Rule 48, which penalizes hits that target an opponent’s head or make the head the principal point of contact. But many of the recent injuries, including Malkin’s, were not caused by hits deemed worthy of fines or suspensions.

Last season, according to CBC network estimates, about 90 players missed games because of concussions, about 13 percent of N.H.L. players on active rosters on a given night. Crosby missed 60 games while recovering from a concussion he sustained in the 2011 Winter Classic.

Malkin, who has 4 goals and 17 assists in 18 games this season, received a concussion diagnosis Sunday, two days after he fell awkwardly into the end boards following a routine shove from Florida’s Erik Gudbranson. Malkin slid back-first into the boards, causing his head to snap sharply backward and strike the boards.

Penguins Coach Dan Bylsma said Malkin initially had short-term memory loss but was improving. The team placed Malkin on injured reserve Monday, retroactive to Sunday. A player on injured reserve is ineligible to play for a minimum of seven days, meaning the soonest Malkin can be reactivated is next Sunday.

“There’s not a specific schedule for that right now in terms of physical activity,” Bylsma told reporters Tuesday in Sunrise, Fla., where the Penguins played the Panthers again.

“The protocol and resting with a concussion, he’s following that right now,” Bylsma added.

The Penguins, who lead the Atlantic Division, have a new medical team this season, headed by Dr. Christopher Harner of the University of Pittsburgh Medical Center, where the team is planning to open a training, sports medicine and performance facility. The Penguins announced in the summer that they had ended their association with their longtime team doctor, Charles Burke.

The team and Burke said that their parting was amicable and not related to Crosby’s 14-month concussion saga. Penguins President David Morehouse said the team “wanted to have enhanced medical coverage for our players,” which included having doctors travel with the team.

Perhaps because of their history with Crosby, the Penguins are among the N.H.L.’s most transparent teams in disclosing concussions, and General Manager Ray Shero is considered a progressive voice in support of tighter rules governing hits to the head and concussion protocol.

A lack of openness about concussions can make it difficult to have an accurate accounting of head injuries. Among the other players with recently announced head injuries are the 20-year-old Carolina forward Jeff Skinner, who missed 16 games last season with a concussion; St. Louis’s high-scoring rookie Vladimir Tarasenko; another top rookie, Brendan Gallagher of Montreal; and Devils winger Ryan Carter.

Under N.H.L. regulations, clubs are not required to disclose the specific nature of a player’s injury. But they are not permitted to give out false or misleading information about an injury.

The Columbus Blue Jackets’ announcement that Artem Anisimov is out with an “upper body injury” is allowed under those guidelines, even though he was taken off the ice in Detroit on a stretcher Thursday after his head was driven into the ice by the elbow of a falling Red Wing, Kyle Quincey.

The Rangers do not always disclose players’ concussions. Rick Nash and Ryan McDonagh are believed to be out of the lineup with concussions, but the team has issued no details regarding their conditions. Forward Darroll Powe was sidelined with a confirmed concussion Feb. 17, but returned to play on Tuesday.

Nash, who has missed four games, returned to practice Tuesday and told reporters that his absence was because of a “number of things.” He declined to confirm or deny that a concussion was among the injuries.

The Rangers have been reluctant to disclose concussions in the recent past. In January 2011, they revealed that the enforcer Derek Boogaard had sustained a concussion in a fight about a month earlier, and in September 2011 they disclosed that defenseman Marc Staal had played more than two months at the end of the previous season with concussion symptoms. Staal did not return to game action until the 2012 Winter Classic.

Denis was promising, but he also was no ordinary fighter. Before turning pro, he was a doctoral student in biochemistry. Following his loss to Sandro, Denis began looking through medical journals, and it was here he discovered a new term: subconcussive trauma.

The new term is also something of a new concept and a bit of a final frontier for brain injury science. Essentially, subconcussions are smaller than full-blown concussions, but over time, can still cause serious harm, including CTE, in the brain.

Thiago Alves had this issue when he was getting medicals from New Jersey SAC. They did an CT and found an issue with vessels in his brain (see link attached). He got the surgery and it saved his life. Had it been in another state, he may not have been so fortunate.

Headgear for amateur boxers to be banned in a bid to REDUCE head injuries

New rules from International Boxing Association (AIBA) apply from June Elite male boxers who compete internationally will not wear headgear Theory is that opponents apply less force if the head is unprotected Research has found that the move actually reduces the risk of concussion

Amateur boxers are to be banned from wearing headgear in a bid to reduce the number of head injuries.

While the move sounds counterintuitive, the theory is that opponents don't apply so much force if the head is unprotected.

The new rules, from the International Boxing Association (AIBA), state that from June 1st, amateur, elite male boxers who compete internationally will be banned from wearing headgear, like their professional counterparts.

Another reason for the move is that headgear can obscure peripheral vision, making it harder to see when a blow is being aimed at the side of the head. Indeed, research has shown that a lack of headgear actually reduces the risk of concussion.Protection: While the move sounds counterintuitive, the theory is that boxers won't hit their opponent's head so hard if it's not protected

Protection: While the move sounds counterintuitive, the theory is that boxers won't hit their opponent's head so hard if it's not protected

In a statement, the AIBA said: 'All available data indicated that the removal of headguard in Elite Men would result in a decreased number of concussions.'

Although cuts will still be a risk, these will heal, as will bones - 'but if you can't recognise your grandchildren, it's a disaster,' Charles Butler, chairman of the AIBA medical commission, told the Wall Street Journal. He has worked on research which formed the basis of the recommendations.

He looked at research involving 15,000 boxers, half of whom had competed with headgear and half without. He found that in the 7,352 rounds that took place with boxers wearing headgear, the rate of concussion was 0.38 per cent, compared with 0.17 per cent per boxer per round in the 7,545 rounds without headgear.

More...

*Exercising four times a week from childhood 'helps stave off dementia and increases brain power by a third'*Amateur boxers have been required to wear headgear since the 1980s after concerns about concussion.

But Mr Butler added that technology meant that gloves have also improved since then, helping to reduce the impact of blows to the head, but some experts have criticised the new guidance, adding that knockouts often come from hits to the chin. And the rules will remain unchanged for women, the theory being that women may lack the strength to administer blows strong enough to cause concussion.

The AIBA announcement comes after new research published in the British Journal of Sports Medicine found there was 'no good evidence that mouthguards and helmets ward off concussion'. The researchers agreed that while they can help ward off other serious head and facial injuries, there was 'no good evidence that they can help prevent concussion, and paradoxically, they may even encourage players to take greater risks'.

The advice comes at a time of increasing evidence that even minor head injuries can be deadly in the long-term. Research published last week suggests that repeated, sub-concussive hits to the head are dangerous and are also linked to neurological disorders, such as multiple sclerosis, later in life. Scientists from the University of Rochester Medical Center say that the brain degeneration observed among professional football players may be due to something in their immune system spiralling out of control.

This could be because it damages the blood-brain barrier - a 'gate' between the brain and bloodstream. When the barrier is working properly, it holds in proteins and molecules that bathe the brain and protect it from foreign substances. With blows to the head, however, the barrier opens slightly and allows some proteins to leak into the bloodstream and possibly attack the brain.

Other recent research from the University of Texas has warned that heading a football could cause brain damage.

They said that a header is classed as a 'minor sub-concussive blow' and have found that young people who play football are less able to perform tasks requiring basic thinking skills than those who avoid the game.

Repeated blows to the head can lead to chronic traumatic encephalopathy (CTE), where sufferers experience memory loss, dementia and depression.

Even a mild injury to the head can cause significant changes in the brain that can persist long after the symptoms of a concussion have faded, a new study reported. The research was based on a new 3 D imaging of the brain and shows that people with injuries to the head might take longer to recover than previously believed. Mild injuries to the brain or concussions during sports can damage the brain, which could take a while to recover. People who have had repeated concussions have experienced severe brain damage.

The present study suggests even though the patient might not complain of any pain or dizziness, the brain is quite vulnerable for a few months after an injury.

"These results suggest that there are potentially two different modes of recovery for concussion, with the memory, thinking and behavioral symptoms improving more quickly than the physiological injuries in the brain," said study author Andrew R. Mayer, PhD, of the Mind Research Network and University of New Mexico School of Medicine in Albuquerque.

The study was based on data from 50 people with concussions and 50 without a known brain injury (control group). All the participants were tested for their memory and thinking abilities two weeks after brain scans. About four months later, 26 patients from each group were asked to take another round of tests and brain scans.

Researchers used diffusion tensor imaging scans for their study. These scans created a 3 D image of the nervous system. Conventionally, brain scans like MRI or CT scans might not pick up the subtle details, researchers told Bloomberg.

"During recovery, reported symptoms like pain are greatly reduced before the body is finished healing, when the tissue scabs. These finding may have important implications about when it is truly safe to resume physical activities that could produce a second concussion, potentially further injuring an already vulnerable brain," Mayer said in a news release.

It was found that even after two weeks post brain injury, people with a concussion had more problems with thinking and memory skills than people who didn't have a concussion. Also, people suffering from a blow to the brain were more likely to have emotional problems like anxiety or depression.

After four months, concussion symptoms had faded in most patients. However, their brains showed significant abnormalities, especially in the gray matter in the frontal cortex area.

CINCINNATI — THE N.F.L. playoffs start tomorrow. During the regular season, the conversation about traumatic brain injuries in sports among doctors, players, league officials, politicians and parents seemed to gain in volume and intensity with each passing week. New revelations from retired N.F.L. players who announced that they had the progressive neurodegenerative brain disease chronic traumatic encephalopathy, or C.T.E., helped fuel these discussions.

The key to beating the concussion crisis lies in dealing with what’s happening inside the skull, not outside of it. Because the brain doesn’t fill the skull, there’s room for it to rattle, be bruised or sheared, not just with every collision but with every sudden stop and even start — a phenomenon sometimes described as “brain slosh.” For athletes in contact sports, brain slosh has long been seen as inherent and unavoidable. But to make progress against concussions, we have to give priority in future research to minimizing brain slosh during game play. This means that we need sports leagues, policy makers and health care providers to emphasize primary prevention instead of damage control.

At the National Conference on Youth Sports Safety in Washington in November, the approaches discussed were almost entirely focused on post-concussion management. The well-intentioned legislation currently under consideration in Congress is also too reactive. It should emphasize the critical role of primary prevention.

Newer helmets don’t seem to make much of a difference, either. Studies appearing in the British Journal of Sports Medicine and the American Academy of Pediatrics found nearly identical rates of sports-related concussions among different helmet brands and models, including older helmets and new. Why? Think about shipping fragile porcelain — do we use steel or titanium containers, or Bubble Wrap? The same principle applies when protecting the brain. Helmets fulfill their primary purpose of preventing skull fractures and lacerations, but they do not reduce concussions. It is the delicate brain within the skull that is damaged because it does not fit snugly. Athletes would benefit from a tighter fit for the brain — a Bubble Wrap effect — during play, but what are the factors within our control that might provide that effect? We have some leads.

At the Cincinnati Children’s Hospital Medical Center, we released a study that found that high school football players who played at higher altitudes sustained a 30 percent reduction in total concussion incidence. We hypothesized that higher altitude increased the volume in the cerebral venous system, a natural Bubble Wrap that surrounds the brain, and that this created a snugger fit inside the skull that protected the athletes from sustaining concussions. We are currently analyzing N.F.L. concussion data from the 2012 and 2013 regular seasons to see if this effect obtains among professionals.

There are also biomechanics in nature worth exploring for today’s athletes.

Bighorn sheep ritually ram their heads into each other and woodpeckers slam their heads against trees thousands of times a day with neither species’ sustaining concussions or even much of a headache, as far as we know. Meanwhile, much lesser forces result in a concussion, or worse, in humans. Our analysis suggests that both woodpeckers’ and Bighorns’ brains are naturally protected with mechanisms that slow the return of blood from the head to the body — increasing blood volume that fills their brains’ vascular tree, creating the Bubble Wrap effect.

We have observed that the woodpecker uses muscles to do this, while the sheep has hollow pneumatic horn cores attached to its respiratory system that allow it to re-breathe its air and thus increase carbon dioxide in its bloodstream, expanding its intracranial vascular tree and enhancing the Bubble Wrap effect.

Every week the lights come on over fields of competition around the world, brightening the lives of players and their fans. Unfortunately, every week the lights dim for too many athletes who suffer the effects of concussions despite rule changes and newer helmets. What’s troubling for sports enthusiasts is that parents and politicians may be making the decision to limit or remove the opportunity for young people to participate in contact sports. Although we cannot play every game in Denver, the winning strategies for defeating the concussion crisis may come from research focused on recreating the safe biomechanics already in use in the animal kingdom.

Gregory D. Myer is the director of research in sports medicine at Cincinnati Children’s Hospital Medical Center.

After Jermichael Finley's recent spinal cord injury, a sportswriting friend of mine shook his head and referred to football as “America's sickness.” As severe as it was, though, Finley's injury wasn't nearly the worst a professional athlete suffered last weekend. On Saturday night, 26-year-old junior featherweight Francisco "Franky" Leal was knocked out by Raul Hirales in the eighth round of a fight in Cabo San Lucas, Mexico and never regained consciousness. He was pronounced dead three days later. If football is America's sickness, what then do we call boxing?

Chronic neurologic impairment has long been recognized as a sequelae of boxing. (CTE—much in the news in recent years due to its association with football—was once known as punch drunkenness, or dementia pugilistica.) This is unsurprising when we learn that being hit by a professional boxer is like being struck by a 13-pound bowling ball swung at 20 mph. After a series of blows to the head, a fighter will often appear glassy-eyed, with observers saying, “The lights are on, but nobody’s home.” Generally, the fighter looks this way because he has just sustained a cerebral concussion, which is marked by a sudden impairment of consciousness, paralysis of certain reflexes, and loss of memory.

We haven’t sorted out just what's happening yet, and some of the details remain controversial, but scientists have discovered that during a traumatic brain injury—the kind boxers routinely experience—cerebral blood flow is diminished and the concentrations of ions like potassium and calcium that live inside and outside of the neurons are disrupted. In addition, neurotransmitters like glutamate are released in excessive amounts. These things cause the brain's neurons to begin to fire excessively. That’s a problem.

Researchers have examined the brain waves of recently concussed animals and determined that their brains resemble that of an animal suffering an epileptic seizure. This comes as a bit of a surprise, because the brain waves (measured by an electroencephalogram) show hyperactivity, which implies that when a fighter is glassy-eyed and unable to answer the referee's questions appropriately, his neurons might actually be overactive, not underactive.

But a hyperactive brain is not the only problem. When the head is hit at high speed, shearing movements within the skull can cause micro-hemorrhages of the blood vessels within the brain tissue. If the shearing force is large enough, or if the head is it hard enough, a large bleed can occur. This becomes a medical emergency because the skull is fixed, enclosed space. As blood accumulates, usually in the form of a subdural hematoma, it can squish the brain and potentially compromise critical neural functions like breathing; death becomes imminent.

Boxers dying isn't exactly rare—there have been a substantial number of fatalities in the sport at both amateur and professional levels due to brain injuries sustained in the ring. The number of such fatalities has decreased a bit in recent years owing to measures taken by authorities to decrease the physical hazards in the ring and to better monitoring of boxers by referees and ringside physicians. Many of these changes occurred after the death of a South Korean boxer you may never have heard of.

On November 13th, 1982, lightweight Duk Koo Kim challenged Ray Mancini, the reigning world lightweight champion, at Caesar Palace in Las Vegas. In the 14th round, Mancini was declared the winner by technical knockout. Moments later, Kim lost consciousness and was taken to a nearby hospital, where he was found to have severe brain swelling and a subdural hematoma. Kim was rushed to the operating room to remove the blood inside his skull, but died four days later.

Kim’s death shook the boxing world. The World Boxing Council conferred with medical advisors, determined that most severe injuries came in rounds 13 through 15, and decided to reduce the number of rounds in championship fights down to 12. (The International Boxing Federation and the World Boxing Organization eventually followed their lead.) Clearly this change was a move in the right direction. Was it enough?

What Makes Boxing So Dangerous?

Generally, it’s easy to see why football and boxing get lumped together as high-risk sports, but it’s important to understand that boxing is much worse. The reason often has to do with the angle of impact rather than the force behind it.

Boxers endure a high prevalence of glancing blows to the head, which results in rotational acceleration. This is different from the biomechanics involved in football, where the impact is more commonly directed at the center of the body, causing something called translational acceleration. The glancing blows in boxing create a rapid rotation of the skull, which carries a higher risk of severe head injury than linear movements, theoretically by creating greater tension on the bridging vessels and brain tissue. It may be counterintuitive, but it probably explains why we’ve actually seen more boxing deaths in the lower weight classes. It’s not the force of impact; it’s the angle. (The man who landed the lethal blow on Saturday night weighed just 123 pounds.)

Knowing this, it’s not hard to argue that boxing simply cannot be made safe. The Journal of the American Medical Association famously declared in an editorial that boxing should be banned in civilized countries. Some have called for sports physicians to make a public statement by ending their professional relationship with boxing.

Others among my colleagues, though, think this sort of high-mindedness is misguided, that boxing is here to stay and that it would be a mistake for doctors to cut ties with the sport. Rather, they argue, we should make the sport safer by insisting on a ringside neurologist, post-concussion assessments, and mandatory neurophysiological assessments for all professional fighters.

Either way, while the NFL is coming in for the closest scrutiny in the head trauma debate, boxing should certainly be under the microscope as well. Football players at least have a union; boxers have the likes of Bob Arum.

Some say the NFL will cease to exist as we know it once a player dies on the field, but boxers are dying in the ring. What are we actually going to do about it? The Wikipedia page of deaths due to injuries sustained in boxing is a sobering reminder of the dangers of the sport, and it doesn’t begin to approach the actual number of boxing-related deaths. How many more need to be added to the list before we do away with this ridiculous sport? Football may be America’s sickness; boxing is one of our tragedies.

Matt McCarthy is board-certified in internal medicine. You can follow him on Twitter here.

On a frigid night recently in Randolph, N.J., the Jersey Wildcats junior hockey team flew across the home rink during practice at Aspen Ice Arena, sending ice into the air. Hockey is known for its collisions, and concussions aren’t unusual, but the players didn’t seem particularly worried.

On the backs of their heads were flashing green lights, signifying that all was well.

“We’ll be behind the bench, and as soon as a player comes back we can look right down and it’ll be a nice light,” said the coach, Justin Stanlick. If the light changes color, “we can know that player needs to go see a trainer to get cleared.”

The light is part of a head impact sensor called the Checklight, made by Reebok. The device is a black skullcap with an electronic strip and three lights on the back. It blinks green when a player has sustained no head impact on the ice, yellow after a moderate impact and red after a severe one. The Checklight relies on an accelerometer and a gyroscope to measure the force of an impact.The Checklight flashes green for no impact, yellow for a moderate blow, red for a severe one.Bryan Thomas for The New York Times The Checklight flashes green for no impact, yellow for a moderate blow, red for a severe one.

Coaches and parents have only to look to see if a player has taken a serious blow. And because the sensors are objective, Reebok executives say, they may lessen the pressure on young athletes to project toughness and play through a concussion.

Gage Malinowski, a 19-year-old defenseman for the Wildcats, recently returned to practice after suffering the latest in a series of concussions during a game in February. “There’s not a game where I don’t have at least 10 hits,” he said.

While chasing a puck behind the net, “I just turned the wrong way and he hit me from behind,” Gage said. “Five minutes later I started to get blurry, and so I didn’t want to risk it.”

Concussions are a growing concern in youth sports, as they are at the higher levels. By one estimate, 300,000 high school and college athletes a year sustain concussions. Experts say the total tally is likely much greater.

While there are no easy solutions, Reebok and other companies are working on high-tech aids. Some are developing impact sensors that can be taped into football helmets or worn as mouth guards. Triax Technologies, in Norwalk, Conn., is testing an impact sensor worn as a headband with various teams, including the University of New Haven women’s soccer team. Reebok plans to release a headband version of the Checklight later this year.

Impact sensors in helmets have been previously available, but typically for $1,000 or more. The Checklight retails for $150.

Experts note that these are imprecise tools, insufficient by themselves to indicate a concussion. Another problem is that an impact that leaves one player concussed may have little effect on another.

Reebok would not disclose its thresholds for determining moderate and severe collisions, only that the Checklight measures linear and rotational acceleration and the duration of the impact.

In January, the Sports Legacy Institute, a nonprofit organization supported by sporting goods manufacturers that aims to limit the number of subconcussive hits sustained by athletes, took a stab at quantifying a concussion threshold. In an initiative modeled after baseball’s pitch count, which limits the number of pitches thrown in hopes of preventing elbow injuries, the institute released a “hit count” white paper stating that what counts as a hit is one involving more than 20 G’s of linear acceleration in a 40-millisecond window.

But a co-author of the paper remained skeptical about applying a definitive threshold and about counting subconcussive hits.

“There is not a known threshold for concussions,” said Kevin Guskiewicz, an exercise and sport science professor at the University of North Carolina at Chapel Hill, who has been studying concussions with similar sensor technology.

“Parents are going to buy a product that’s potentially going to protect their kid, but it can be very misleading,” Dr. Guskiewicz added. “The science hasn’t evolved to the point where we can interpret these metrics.”

Though the science isn’t there yet, the Wildcats serve as an early indication that the sports marketplace is evolving. They are the first hockey team Reebok has outfitted with the Checklight as part of the company’s program to “seed” teams.

At the recent practice, Rich Zuckerman of Florham Park, N.J., watched his 15-year-old son, Steven, skate with the team that he may eventually join. He wasn’t wearing a Checklight, and this was the first Mr. Zuckerman had heard of it.

“If it works, it’s great,” he said, with good reason. Two years ago, Steven sustained four concussions over a four-day period that included a football practice, two hockey games and a football game. He was out for six weeks.

“We want to see the players long term,” said Mr. Stanlick, the Wildcats’ coach. “We want to see them stay in the sport and enjoy it.”